title: High-sensitivity C-reactive protein and silent myocardial ischemia in Chinese with type 2 diabetes mellitus.
abstract: Coronary artery disease (CAD) is a major cause of morbidity and mortality in patients with type 2 diabetes mellitus. When diabetes exists in patients with established CAD, absolute risk for future events is very high. Diabetic patients often have severe, yet asymptomatic, CAD. Although high-sensitivity C-reactive protein (hsCRP) is a strong independent risk factor for cardiovascular events, there is an unclear association between it and silent myocardial ischemia in diabetic patients. In this study, we assess the relationship between hsCRP and silent myocardial ischemia in Chinese with type 2 diabetes mellitus. We designed a cross-sectional study with 225 asymptomatic diabetic patients having no known CAD. Ischemia was assessed by myocardial perfusion imaging. A total of 109 patients (48.4%) was found to have silent myocardial ischemia. Logistic regression analysis revealed age (odds ratio = 4.01, P = .002) (95% confidence interval, 1.98-7.44) and hsCRP (odds ratio = 2.58, P = .005) (95% confidence interval, 1.33-5.01) to be associated with greater risk of silent myocardial ischemia. Using the American Diabetes Association screening guidelines to evaluate risk, we found silent myocardial ischemia to be equally distributed between diabetic patients with 2 or more cardiac risk factors and those with less than 2 risk factors. Twenty-seven (24.8%) patients with silent myocardial ischemia were missed when the American Diabetes Association guidelines were used alone. High-sensitivity C-reactive protein was associated with silent myocardial ischemia in our study. High-sensitivity C-reactive protein might help detect silent myocardial ischemia in diabetic Chinese who may need aggressive treatment to reduce future CAD morbidity and mortality in Taiwan.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University/Chung-Ho Memorial Hospital, 80756 Kaohsiung, Taiwan. minga0531@gmail.com
authors.forename: Ming-Chia
authors.initials: MC
authors.lastname: Hsieh
authors.forename: Kai-Jen
authors.initials: KJ
authors.lastname: Tien
authors.forename: Shun-Jen
authors.initials: SJ
authors.lastname: Chang
authors.forename: Daw-Shyong
authors.initials: DS
authors.lastname: Perng
authors.forename: Jeng-Yueh
authors.initials: JY
authors.lastname: Hsiao
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Chen
authors.forename: Yu-Hung
authors.initials: YH
authors.lastname: Chang
authors.forename: Hsuan-Wen
authors.initials: HW
authors.lastname: Kuo
authors.forename: Pi-Chen
authors.initials: PC
authors.lastname: Lin
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D011877:Radionuclide Imaging; D012307:Risk Factors
chemical_list: D002097:C-Reactive Protein